Substrate-dependent risk stratification for implantable cardioverter defibrillator therapies using cardiac magnetic resonance imaging: The importance of T1 mapping in nonischemic patients

Autor: Reza Razavi, Mark D O'Neill, Zhong Chen, Amedeo Chiribiri, Jaswinder Gill, Francis Murgatroyd, Gerald Carr-White, Benjamin Sieniewicz, Christopher A. Rinaldi, Julian Bostock, Simon Claridge, Jonathan M. Behar, Tom Jackson, Bradley Porter, Silvia Mennuni
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Population
Cardiomyopathy
Magnetic Resonance Imaging
Cine
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
QRS complex
Electrocardiography
0302 clinical medicine
Cardiac magnetic resonance imaging
Physiology (medical)
Internal medicine
medicine
Clinical endpoint
Humans
030212 general & internal medicine
Longitudinal Studies
Prospective Studies
Prospective cohort study
education
Aged
Aged
80 and over
education.field_of_study
medicine.diagnostic_test
business.industry
Middle Aged
Implantable cardioverter-defibrillator
medicine.disease
Defibrillators
Implantable
Ventricular fibrillation
Ventricular Fibrillation
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Cardiomyopathies
Follow-Up Studies
Zdroj: Journal of cardiovascular electrophysiology. 28(7)
ISSN: 1540-8167
Popis: Introduction The role of implantable cardioverter defibrillators in non-ischemic cardiomyopathy is unclear and better risk-stratification is required. We sought to determine if T1 mapping predicts appropriate defibrillator therapy in patients with non-ischemic cardiomyopathy. We studied a mixed cohort of ischemic and non-ischemic patients to determine whether different CMR applications (T1 mapping, late gadolinium enhancement and Grayzone) were selectively predictive of therapies for the different arrhythmic substrates. Methods and Results We undertook a prospective longitudinal study of consecutive patients receiving defibrillators in a tertiary cardiac center. Participants underwent CMR myocardial tissue-characterization using T1 mapping and conventional CMR scar assessment before device implantation. QRS duration and fragmentation on the surface electrocardiogram were also assessed. The primary endpoint was appropriate defibrillator therapy. One hundred thirty patients were followed up for a median of 31 months (IQR (+/-9 months). In non-ischemic patients T1_native was the sole predictor of the primary endpoint (HR 1.12 per 10ms increment in value (95% C.I 1.04-1.21; p≤0.01). In ischemic patients, Grayzone_2SD-3SD was the strongest predictor of appropriate therapy (HR 1.34 per 1% left ventricular increment in value (95% C.I 1.03-1.76;p = 0.03). QRS fragmentation correlated well with myocardial scar core (ROC AUC 0.64; p = 0.02) but poorly with T1_native (ROC AUC 0.4) and did not predict appropriate therapy. Conclusions In the medium-long term, T1_native mapping was the only independent predictor of therapy in non-ischemic patients whereas Grayzone was a better predictor in ischemic patients. These findings suggest a potential role for T1_native mapping in the selection of patients for ICDs in a non-ischemic population. This article is protected by copyright. All rights reserved
Databáze: OpenAIRE
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